Blue - Blue Cross® Premier PPO Bronze Extra

Michigan, 2017

  • Plan Type

    PPO

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $7,150

  • Deductible

    $6,650

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $6,650
Deductible (Family) $13,300
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit $45 Copay before deductible + 50% Coinsurance after deductible
Specialist Visit 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible
Emergency Room Services 50% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 50% Coinsurance after deductible
Laboratory Outpatient and Professional Services 50% Coinsurance after deductible
X-Ray and Diagnostic Imaging 50% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 50% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 50% Coinsurance after deductible
Outpatient Facility 50% Coinsurance after deductible
Outpatient Surgery 50% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx 35% Coinsurance after deductible
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 45% Coinsurance after deductible

Other Plans in Michigan

Plan Blue Cross® Premier PPO Silver Deductible $1,800 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Premier PPO Bronze Saver Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® PPO Gold Extra with Dental and Vision, a Multi-State Plan Deductible $1,250 Coinsurance Not applicable Out of Pocket $4,750
Plan Blue Cross® Premier PPO Gold Deductible $250 Coinsurance Not applicable Out of Pocket $5,100
Plan Blue Cross® Premier PPO Bronze HSA Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross® Metro Detroit EPO Silver Well-Being Deductible $3,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Blue Cross® Metro Detroit EPO Bronze HSA Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross® Premier PPO Silver Saver HSA Deductible $4,000 Coinsurance Not applicable Out of Pocket $4,500
Plan Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Premier PPO Value Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Premier PPO Silver Extra Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $6,650
Deductible (Family) $13,300
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit $45 Copay before deductible + 50% Coinsurance after deductible
Specialist Visit 50% Coinsurance after deductible
Inpatient Facility 50% Coinsurance after deductible
Inpatient Physician 50% Coinsurance after deductible
Emergency Room Services 50% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 50% Coinsurance after deductible
Laboratory Outpatient and Professional Services 50% Coinsurance after deductible
X-Ray and Diagnostic Imaging 50% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Available
Pregnancy Available
Weight Loss Available

Other

Mental / Behavioral Health Inpatient 50% Coinsurance after deductible
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy 50% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 50% Coinsurance after deductible
Outpatient Facility 50% Coinsurance after deductible
Outpatient Surgery 50% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx 35% Coinsurance after deductible
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 45% Coinsurance after deductible

Other Plans in Michigan

Plan Blue Cross® Premier PPO Silver Deductible $1,800 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Premier PPO Bronze Saver Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® PPO Gold Extra with Dental and Vision, a Multi-State Plan Deductible $1,250 Coinsurance Not applicable Out of Pocket $4,750
Plan Blue Cross® Premier PPO Gold Deductible $250 Coinsurance Not applicable Out of Pocket $5,100
Plan Blue Cross® Premier PPO Bronze HSA Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross® Metro Detroit EPO Silver Well-Being Deductible $3,500 Coinsurance Not applicable Out of Pocket $6,000
Plan Blue Cross® Metro Detroit EPO Bronze HSA Deductible $6,550 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Cross® Premier PPO Silver Saver HSA Deductible $4,000 Coinsurance Not applicable Out of Pocket $4,500
Plan Blue Cross® PPO Silver Extra with Dental and Vision, a Multi-State Plan Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Premier PPO Value Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross® Premier PPO Silver Extra Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,150